The next step was particularly critical: the placement of the arterial infusion cannula into the aorta to perfuse the coronary arteries. It would be through this cannula that the cardioplegia solution would be introduced that would stop the heart with its high potassium, cool it, and nourish it during the procedure. The problem was that the arterial pressure had to be dealt with.
“Scalpel,” Kim said.
The scrub nurse slapped the scalpel with the appropriate blade into his waiting palm.
Kim lowered the razor-sharp instrument into the wound and directed it toward the aorta. The knife trembled in his hand; Kim wondered if Tom noticed.
Kim made a quick stab into the aorta then covered the incision with the tip of his left index finger. He did it quickly so that there was little blood loss. The little blood that appeared was cleared by Tom.
“Arterial infusion cannula,” Kim said.
The instrument was placed in his waiting hand. He introduced it into the wound and positioned it next to his finger, occluding the stab wound into the aorta. Sliding the tip under his finger, he tried to push it into the pulsating vessel. For reasons not clear to him, the cannula would not penetrate the vessel wall. Arterial blood was now spurting out.
Uncharacteristically, Kim panicked. With blood filling the wound, he pushed too hard with the instrument and tore the aorta, enlarging the opening. Now the stab wound was too big to seal around the cannula’s bulbous tip. Blood squirted high enough to splatter against Kim’s plastic face shield.
Kim now faced a surgical emergency. Instead of panicking more, his experience kicked in. Rapidly recovering his composure, he reached into the wound with his left hand. Blindly his finger found the hole in the pulsating vessel, and he pressed against it, partially stemming the blood. Tom rapidly sucked out enough of the blood to give Kim a partial view.
“Suture!” Kim barked.
A needle-holder trailing a length of black silk was pressed into his hand. Deftly he passed the needle’s tip into the vessel’s wall. He did this several times so that when he pulled up on the suture the hole was closed.
With the emergency quickly contained, Kim and Tom eyed each other across the patient. Tom motioned with his head, and Kim nodded. To the surprise of the team, Kim and Tom stepped away from the operative field. They kept their sterile gloved hands pressed against their sterile gowned chests.
“Kim, why don’t you let me finish this last case?” Tom whispered. It was a suggestion for Kim’s ears only. “I can pay you back for doing the same for me a couple of weeks ago when I was coming down with the flu. Remember?”
“Sure I remember,” Kim said.
“You’re understandably bushed,” Tom said.
It was true: Kim was exhausted. He had spent most of the night in the ICU waiting room with Tracy. When it had become apparent that Becky’s condition had stabilized, Tracy convinced Kim to get a few hours’ rest in one of the resident on-call rooms. She’d also been the one to convince Kim to go ahead with his planned surgery, arguing that his patients needed him. She’d insisted that it was best for Kim to stay busy since there wasn’t anything he could do for Becky besides wait. Her most convincing point had been that he’d be in the hospital and available if needed.
“How did we do this as residents?” Kim asked. “We never had any sleep.”
“The benefit of youth,” Tom said. “The problem is we’re no longer young.”
“How true,” Kim commented. He paused for a moment. Turning his case over to anyone, even to someone as qualified as Tom, was not an easy decision for him. “All right,” he said at length. “You take over. But I’ll be watching you like a hawk.”
“I wouldn’t expect anything different,” Tom joked. He knew Kim well enough to recognize his style of humor.
The two surgeons returned to the operating table. This time Tom was on the patient’s right.
“All right, everybody,” Tom said. “Let’s get that cannula in. Scalpel, please!”
With Tom at the helm, the operation went smoothly. Although Kim was on the patient’s left, he was the one who positioned the valve and placed the initial sutures. Tom did the rest. As soon as the sternum was closed, Tom suggested Kim should bow out.